Provider Demographics
NPI:1053324566
Name:WILLIAM ST JOHN LACORTE, PMC
Entity Type:Organization
Organization Name:WILLIAM ST JOHN LACORTE, PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:LACORTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-838-6000
Mailing Address - Street 1:PO BOX 55336
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70055-5336
Mailing Address - Country:US
Mailing Address - Phone:504-838-6000
Mailing Address - Fax:504-835-6685
Practice Address - Street 1:519 METAIRIE RD
Practice Address - Street 2:STE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005
Practice Address - Country:US
Practice Address - Phone:504-838-6000
Practice Address - Fax:504-835-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1524022370OtherBCBS OF LA
LA1944556Medicaid
LA1524022370OtherBCBS OF LA
B64926Medicare UPIN